On January 1st 1986, all hypnotics and sedatives containing barbiturates were removed from the Danish Drug Register. After one year, a follow-up investigation of previous barbiturate users was undertaken with the object of investigating the significance of various factors for cessation or continuation of use of psychotropic drugs in connection with the removal of barbiturates from the Danish Drug Register. The investigation was carried out of a questionnaire investigation in general practice with participation of 82 practices. Information was obtained concerning 141 previous barbiturate users. Twenty-four of these had stopped (17%, 95% confidence limits 11-23) having psychotropic drugs prescribed during the course of the year in question. In particular, patients without or with slight mental conditions ceased using drugs (p = 0.02). An age and sex stratified analysis revealed that more patients who had obtained the preparation by direct doctor-patient contact stopped the habit (odds ratio 3.00, 95% confidence limits 1.04-8.61). Other factors were without significant significance for continued use or cessation, respectively. In 75% of the patients, adjustment was, in the opinion of the general practitioner, easy. Out of 105 patients who continued to have psychotropic drugs prescribed and where the preparation employed was known, 90 (86%) were prescribed benzodiazepines.
Few studies have examined changes in the pain experience of patients with COPD and predictors of pain in these patients.
The objectives of the study were to examine whether distinct groups of COPD patients could be identified based on changes in the occurrence and severity of pain over 12 months and to evaluate whether these groups differed on demographic, clinical, and pain characteristics, and health-related quality of life (HRQoL).
A longitudinal study of 267 COPD patients with very severe COPD was conducted. Their mean age was 63 years, and 53% were females. The patients completed questionnaires including demographic and clinical variables, the Brief Pain Inventory, and the St Georges Respiratory Questionnaire at enrollment, and 3, 6, 9, and 12 months follow-up. In addition, spirometry and the 6 Minute Walk Test were performed. Latent class analysis was used to identify subgroups of patients with distinct pain profiles based on pain occurrence and worst pain severity.
Most of the patients (77%) reported pain occurrence over 12 months. Of these, 48% were in the "high probability of pain" group, while 29% were in the "moderate probability of pain" group. For the worst pain severity, 37% were in the "moderate pain" and 39% were in the "mild pain" groups. Females and those with higher body mass index, higher number of comorbidities, and less education were in the pain groups. Patients in the higher pain groups reported higher pain interference scores, higher number of pain locations, and more respiratory symptoms. Few differences in HRQoL were found between the groups except for the symptom subscale.
Patients with COPD warrant comprehensive pain management. Clinicians may use this information to identify those who are at higher risk for persistent pain.
In addition to their respiratory symptoms, patients with COPD experience multiple, co-occurring symptoms.
The aims of this study were to identify subgroups of COPD patients based on their distinct experiences with 14 symptoms and to determine how these subgroups differed in demographic and clinical characteristics and disease-specific quality of life.
Patients with moderate, severe, and very severe COPD (n=267) completed a number of self-report questionnaires. Latent class analysis was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of self-reported symptoms using the Memorial Symptom Assessment Scale.
Based on the probability of occurrence of a number of physical and psychological symptoms, three subgroups of patients (ie, latent classes) were identified and named "high", "intermediate", and "low". Across the three latent classes, the pairwise comparisons for the classification of airflow limitation in COPD were not significantly different, which suggests that measurements of respiratory function are not associated with COPD patients' symptom burden and their specific needs for symptom management. While patients in both the "high" and "intermediate" classes had high occurrence rates for respiratory symptoms, patients in the "high" class had the highest occurrence rates for psychological symptoms. Compared with the "intermediate" class, patients in the "high" class were younger, more likely to be women, had significantly more acute exacerbations in the past year, and reported significantly worse disease-specific quality of life scores.
These findings suggest that subgroups of COPD patients with distinct symptom experiences can be identified. Patients with a higher symptom burden warrant more detailed assessments and may have therapeutic needs that would not be identified using current classifications based only on respiratory function.
This is the first report of a major foodborne outbreak of enterohaemorrhagic Escherichia coli (EHEC) in Sweden. It occurred among the nursing staff at a children's hospital with approximately 1600 employees. Contaminated lettuce was the most likely source of infection. Nine persons were culture-positive for Escherichia coli (E. coli) O157 and verocytotoxin-positive by PCR and a further two were verocytotoxin-positive by PCR only. All 11 EHEC-positive individuals had attended a party for approximately 250 staff members, which was held at the hospital. In a questionnaire 37 persons stated that they had symptoms consistent with EHEC infection during the weeks after the party. There was no evidence of secondary transmission from staff to patients. The value of PCR as a sensitive and fast method for diagnosis is discussed in this paper. Pulsed-field gel electrophoresis (PFGE) was used to ascertain that staff members were infected by the same clone, and that two patients with E. coli O157 infection were not.
During one week in 1985, 227 general practitioners (GPs) in the county of Aarhus, Denmark, recorded all their prescriptions of psychotropic drugs, amounting to 4,180 prescriptions for 3756 patients. There was great variation in the rate of prescribing among the GPs. The median number of prescribed defined daily doses per 1,000 registered patients per day was 84, and the corresponding median number of prescriptions per 1,000 patients per week was 14. There was a significantly lower rate of prescribing of psychotropic drugs by rural/small town GPs, compared with GPs in major cities (odds ratio, 0.84; 99% confidence limits, 0.77-0.91), after correction for differences in patients' age and sex. There were no differences in rate of prescribing among GPs in relation to size and type of practice, nor to the age and sex of the GP.
Do various General Practice factors influence the participation rate (PR) in the cytological investigation for preventing cancer of the cervix uteri in counties without systematized screening? This was studied in the county of Aarhus, Denmark, where there are no systematic cytological examinations (CE). We studied a random sample of 2023 women aged 27.5 years to 47.5 years. Essential differences in PR depended on various practice characteristics. Practices with the highest average use of CE services, as counted by the Regional Health Authorities, also had the best PR. The relative chance of being sufficiently examined was almost twice as great among patients in active practices compared with other practices. Furthermore, practices with at least one female practitioner and practices that wanted the introduction of systematic screening had a significantly higher PR. There was a slightly higher PR for patients in large practices. Type of practice, i.e. whether single or partnership, and the individual practitioner's attitude to the efficiency of the present opportunistic screening were not related to the PR. Finally, a slightly lower PR was found among patients in the city of Aarhus, whereas the PR in the major cities of the county as a whole did not differ from the coverage rate in the county in general. It is concluded that the Health Authorities' average figure for CE-use/1000 women in the individual practice is the most significant factor that determines the CE rate for any given patient. Variation in the PR in different practices is unacceptably large if all the women are to receive a uniform CE screening offer.
Twenty-six consecutive patients with primary biliary cirrhosis (PBC) from northern Sweden were studied regarding the occurrence and features of Sjögren's syndrome (SS). In more than 50% of the patients the rose bengal dye test showed conjunctival and/or corneal staining. In six patients keratoconjunctivitis sicca (KCS) was present with positive rose bengal and Schirmer tests. In a further three patients only the results of the Schirmer tests were abnormal. Radiological findings of sialectasia were demonstrated in six patients, five of whom had KCS. Two of the seven patients who fulfilled our criteria for Sjögren's syndrome were HLA-B8 positive. A high prevalence of increased immune globulins and rheumatic factor was found, but this did not correlate with the presence of Sjögren's syndrome. Some features of Sjögren's syndrome were found in 73% of PBC patients, and keratoconjunctivitis sicca and/or sialectasia were found in 27% of PBC patients. This constitutes a high frequency of secondary manifestations of the liver disease.
The object of this investigation was to illustrate the attitudes of general practitioners to prescription of psychotropic drugs and to mental illness. The qualitative research interview method was chosen as the method employed here. Fourteen general practitioners were interviewed while one did not wish to participate. A marked difference was found between the attitudes of the general practitioners to respect the autonomy of the patients or to act paternally. The paternal general practitioner could either prescribe psychotropic drugs on his own initiative or refuse prescription. General practitioners who respected autonomy were relatively restrictive in their prescribing habits so that respect for autonomy was by no means expression for free prescription of psychotropic drugs. Their goal was that the patient should be placed in a situation where he/she could choose and determine personally. The general practitioners considered that their undergraduate and postgraduate training in treating patients with mental illness was inadequate. Taking into consideration how frequently patients with conditions of this nature are seen in general practice, this must be regarded as a serious deficit in medical training. A number of general practitioners have, however, received postgraduate training in this subject. General practitioners did not consider patients who consulted them with mental conditions as mentally ill but they did not have an alternative disease model by which they could classify the problems and complaints of these patients.
The object of this investigation was to describe prescription of psychotropic drugs by general practitioners in relation to their training and attitudes to employment of psychotropic drugs in the treatment of psychosocial conflicts. The investigation was carried out as a multicentre questionnaire investigation in the County of Aarhus in which 192 (89%) out of 215 general practitioners who were invited participated. In brief and prolonged psychosocial conflicts, 58 (31%) and 149 (81%), respectively, considered that prescription of psychotropic drugs constituted poor treatment. More than half of the general practitioners found that the amounts of psychotropic drugs prescribed by themselves and other general practitioners were excessive and that they were, themselves, responsible for this. The majority of the general practitioners found that their attitudes were of great significance for their prescriptions of psychotropic drugs and 71 out of 191 practitioners (37%) found that the pressure of work usually or frequently influenced this. A total of 107 (56%) had had appointments in psychiatric departments (average duration six months) prior to establishment as general practitioners. A total of 117 (61%) had received some form of postgraduate psychiatric training after establishment as general practitioners while 29 (20%) had not received any form of psychiatric training or postgraduate psychiatric education. No connection could be demonstrated between psychiatric training and the extent of prescription of psychotropic drugs.